Penile fracture: MRI demonstration of a urethral tear associated with a rupture of the corpus cavernosum

Urethrography for diagnostic of penile fracture with ruptured anterior urethra and right corpus cavernosum

Penile fracture is a rare urological emergency that effect due to blunt trauma on erect penis. Mostly often occurs during sexual intercourse and is rare in blunt of trauma from impact at penile. That trauma it can caused by rupture and hematoma of tunica albuginea. In physical examination, we found swelling and hematoma of penile shaft, with abnormal angulation to the right and tenderness. Two hours after sexual intercourse, patient urinated and he felt fresh blood comes out with urine and it is painful. Penile fracture can be diagnostic with clinically and imaging radiology. Important information due clinically with précising radiologist finding can making the correct diagnosis and surgical procedure can be done immediately.

Fracture of the Penis: Demonstration by MRI with Surgical Correlation

MRI of a 21-year-old man with a penile fracture demonstrated disruption of the tunica albuginea and adjacent hematoma. Both MRI and subsequent retrograde uretrogram showed that the urethra was not injured. The imaging findings were confirmed at surgery, and the penis was successfully repaired.

National Patterns of Urethral Evaluation and Risk Factors for Urethral Injury in Patients With Penile Fracture

OBJECTIVE

To examine the epidemiology and timing of penile fracture, patterns of urethral evaluation, and risk factors for concomitant urethral injury.

MATERIALS AND METHODS

The National Inpatient Sample (2003-2011) was used to identify patients with penile fractures. Clinical data included age, race, comorbidity, insurance, hospital factors, timing, hematuria, and urinary symptoms. Rates of formal urethral evaluation (cystoscopy or urethrogram) and urethral injury were calculated. Multivariate logistic regression was used to identify predictors of urethral evaluation and risk factors for urethral injury.

RESULTS

A weighted population of 3883 patients with penile fracture was identified. Presentations during weekends (37%) and summers (30%) were overrepresented (both P <.001). Urethral evaluation was performed in 882 patients (23%). Urethral injury was diagnosed in 813 patients (21%) with penile fracture. There was an increased odds of urethral evaluation with hematuria (odds ratio [OR] = 2.99; 95% confidence interval [CI], 1.03-8.73; P = .045) and a decrease for Hispanics (OR = 0.42; 95% CI, 0.22-0.82; P = .011). Older age (32-41 years: OR = 1.84; 95% CI, 1.07-3.16; P = .027; >41 years: OR = 2.25; 95% CI, 1.25-4.05; P = .007), black race (OR = 1.93; 95% CI, 1.12-3.34; P = .018), and hematuria (OR = 17.03; 95% CI, 3.20-90.54; P = .001) were independent risk factors for urethral injury.

CONCLUSION

Penile fractures, which occur disproportionately during summer and weekends, were associated with a 21% risk of urethral injury. Urethral evaluations were performed in a minority of patients. Even in patients with hematuria, 55% of patients underwent formal urethral evaluation. On multivariate analysis of patients with penile fracture, hematuria as well as older age and black race were independently associated with concomitant urethral injury.

[Sex-related injuries]

OBJECTIVE

To describe the injuries occurring during consensual or not sexual intercourses, or during particular sexual practices and their medical, surgical and forensic care.

METHODS

We reviewed the literature using PubMed database to clarify the diagnostic and therapeutic approach of: (1) in men: fracture of the corpora cavernosa, penile and urethral foreign bodies (piercing, rings) as well as amputation of penis; (2) in women: trauma during consensual or not sexual intercourses.

RESULTS

In men, the most common pathology is the rupture of the tunica albuginea of the corpora cavernosa on the erect penis. The diversity of sexual practices, however, exposes urologists to meet trauma less ordinary: strangulation of the penis by rings, genital piercing complications or introduction of foreign bodies into the urethra or under the skin. Less common are traumatic amputations of the penis. In women, sexual trauma are often benign in their clinical presentation but generally occur in the context of sexual violence and require psychological support, forensic and prevention of sexually transmitted infections.

CONCLUSION

The literature is mainly based on expert opinion and single-center retrospective series. We summarized for each situation epidemiology, diagnosis and treatment.

Penile fracture: long-term results of surgical and conservative management

BACKGROUND

Penile fracture usually results from direct trauma to the erected penis. We evaluate the outcomes of surgical and conservative treatment.

METHODS

Between February 2000 and February 2007, 77 patients with mean age 29 ± 2.5 years (range, 20-57 years) with penile fracture were evaluated retrospectively. A total of 56 patients (group A) were treated with immediate surgical repair and 21 patients (group B) were treated conservatively as they refused surgical intervention. Data on erectile function and any penile sequel were obtained during follow-up using the International Index of Erectile Function (IIEF-15) questionnaire, local examination, and color Doppler ultrasonography reports.

RESULTS

Only 69 patients were available for median follow-up period of 20.8 months (range, 17-30 months), 51 patients of the group A and 18 of the group B. Injury involved unilateral and bilateral corporeal rupture in 50 and 6 cases, respectively. Concomitant urethral injury was detected in three cases. During follow-up, 49 cases (96%) of the surgical group (A) and 9 cases (50%) of the conservative group (B) reported erection adequate for intercourse, with no voiding dysfunction and no penile curvature. However, the remaining nine patients (50%) from the conservative group (B) reported erectile dysfunction and penile deviation.

CONCLUSIONS

Immediate surgical repair of the penile fracture gave good results and is superior to conservative treatment; however, we cannot distinguish false from true penile fracture accurately to determine on whom we can use the conservative treatment.

Penile fracture with bilateral corporeal rupture and complete urethral disruption: case report and literature review

Penile fracture is a rare injury most commonly sustained during sexual intercourse. We report the case of a 35-year-old man who presented with bilateral rupture of the corpora cavernosa and complete disruption of the urethra. A review of the literature on penile fracture is also presented. Urgent surgical exploration was performed and the injuries repaired primarily. In follow-up, the patient reported satisfactory erectile function. This case highlights the importance of early surgical repair and evaluation for concomitant urethral injuries in cases of penile fracture.

Long-term significance of the number of hours until surgical repair of penile fractures

OBJECTIVES

We investigated whether a delay in time until surgery, in terms of hours, has any effect on the overall long-term results of surgical repair of penile fractures.

METHODS

Between 2001 and 2009, we operated on 56 patients with penile fractures. We evaluated 43 patients sorted into 3 groups according to the time interval until surgery. We applied the validated Turkish version of the International Index of Erectile Function (IIEF) questionnaire 3 times: for the time period before the fracture, 1 year after the fracture, and at the time of the study. An erectile dysfunction score was calculated for every patient.

RESULTS

Overall, the mean follow-up was 46.1 ± 19.2 months. The mean number of hours from trauma to surgery was 11.3 ± 8.5. There was no statistically significant difference between the 3 groups in terms of age and length of tears. The results of the IIEF questionnaires of each group for time periods and for individual patients in each separate group were statistically similar.

CONCLUSIONS

Surgical repair has a good functional outcome and low complication rates in the long term. Neither serious deformities nor erectile dysfunction occur as a consequence of a delay in surgery in the long term in patients with no urethral involvement within a given period of time.

Imaging of the Male Urethra

For imaging of the male urethra, conventional radiographic contrast studies including retrograde urethrography are most commonly utilized. They are best suited for delineating luminal abnormalities of the urethra and thus are commonly used as the primary imaging modality for patients with various urethral abnormalities such as trauma, inflammation, and stricture. More recently, the cross-sectional imaging techniques of ultrasound, computed tomography and magnetic resonance imaging have been utilized increasingly for urethral and periurethral abnormalities. These studies are most valuable as an adjunctive tool in patients with the complex anatomical derangements such as congenital anomalies, posterior (or bulbomembranous) urethral injuries, and with urethral or periurethral tumors. These cross-sectional techniques can be performed during micturition or with retrograde injection of saline or jelly through the urethral meatus to improve visualization of the urethral luminal abnormalities. This article describes imaging techniques, anatomy, and findings of various urethral and periurethral pathology in the male including congenital anomalies, infection/inflammation, stricture, traumatic injury, fistula, tumors, and calculi.

Imaging of urethral disease: a pictorial review

Retrograde urethrography and voiding cystourethrography are the modalities of choice for imaging the urethra. Cross-sectional imaging modalities, including ultrasonography, magnetic resonance (MR) imaging, and computed tomography, are useful for evaluating periurethral structures. Retrograde urethrography is the primary imaging modality for evaluating traumatic injuries and inflammatory and stricture diseases of the male urethra. Sonourethrography plays an important role in the assessment of the thickness and length of bulbar urethral stricture. Although voiding cystourethrography is frequently used to evaluate urethral diverticula in women, MR imaging is highly sensitive in the demonstration of these entities. MR imaging is also accurate in the local staging of urethral tumors.

The management of penile fracture based on clinical and magnetic resonance imaging findings

OBJECTIVE

To present our experience with repairing penile fracture, based on clinical and magnetic resonance imaging (MRI) findings.

PATIENTS AND METHODS

Between December 2002 and October 2004, 14 men (19-64 years old) presented to our centre with a penile fracture. Two patients had urethral bleeding. MRI was used before surgery in all patients, and the repair comprised a localized longitudinal penile incision in 13 men. This incision was designed according to the tunical tear site and size already depicted by MRI. One case was managed conservatively, as MRI confirmed an intercavernosal haematoma with no tunical tear. The follow-up was 4-21 months.

RESULTS

The tear involved one corpus cavernosum in 11 patients; two were associated with urethral injury. The course after repair was uneventful in all men; the follow-up showed no erectile dysfunction in any. The patients reported neither pain nor penile curvature during erection.

CONCLUSION

MRI is a simple and informative investigation for evaluating and documenting a penile fracture, and it improves the management plan.

MR imaging of the penis

The signal intensity of the corpora cavernosa of the penis at magnetic resonance (MR) imaging may vary from that of the corpus spongiosum; this difference is dependent on the rate of blood flow within the cavernous spaces that constitute the corporal bodies. Also visible at MR imaging are the layers of fibrous tissue that envelop the corporal bodies, the deep arteries and veins, subcutaneous connective tissue, tunica dartos, epidermis, and urethra. While the iliac, pudendal, perineal, and common penile arteries can be evaluated with three-dimensional MR angiography, the smaller end arteries of the penis have not yet been reliably demonstrated. MR imaging may be used to detect and stage penile and urethral cancers, identify and characterize benign penile masses, evaluate arteriogenic impotence, identify penile fractures, evaluate penile prostheses, localize periurethral abscesses, and identify plaques of Peyronie disease. With its direct multiplanar imaging capabilities, superb soft-tissue contrast, and excellent spatial resolution, high-field surface coil MR imaging can show the soft-tissue and vascular anatomy of the penis, as well as the appearance of many penile diseases.